OBJECTIVE: To explore the forensic pathological features of death caused by anaphylactic shock. METHODS: One hundred and forty-two death cases of anaphylactic shock were retrospectively analyzed. The IgE level in the serum of anaphylactic shock cases were statistically compared with that of 62 non-anaphylactic shock cases. RESULTS: Most cases (77.46%) of anaphylactic shock death occurred in the medical institutes, with intravenous drug administration accounting for 53.53% of anaphylactic shock death. β-Lactam antibiotics, glucocorticoid and herbal medications were responsible for a significant proportion of such cases. Although characteristic histopathological changes were absent in vast majority of these anaphylactic shock cases, the differences of IgE levels in the serum between anaphylactic shock group and non-anaphylactic shock group were statistically significant (P<0.05). CONCLUSION Combined information including clinical data, autopsy results, IgE level, and other specific test results should be evaluated together in the forensic pathological diagnosis of anaphylactic shock.
Anaphylaxis ; Autopsy ; Cause of Death ; Forensic Pathology ; Humans ; Infusions, Intravenous ; Retrospective Studies ; Serum

Active surveillance (AS) is currently accepted as a good management option for men with low-risk prostate cancer (PCa). Moreover, given the grade migration following the 2005 International Society of Urologic Pathology consensus conference, AS may be appropriate for men presenting with favorable intermediate-risk PCa. Three contemporary experiences of AS for men with intermediate-risk features suggest that although these men are at higher risk for radical treatment, most of them are not significantly compromising chances for long-term cure. From the long-term randomized ProtectT trial, 10-year outcomes after active monitoring, surgery, or radiotherapy for localized PCa revealed that PCa specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Multiparametric magnetic resonance imaging, molecular biomarkers, and new Gleason grading system could enhance diagnostic accuracy and decrease the demerits of current AS protocols. Particularly, uniform recording of the percentage pattern 4 in Gleason 7 cancers will enable better understanding of prognostic risks and consideration of careful expansion of AS to populations with minimal Gleason pattern 4 disease.
Biomarkers ; Clothing ; Consensus ; Humans ; Magnetic Resonance Imaging ; Male ; Mortality ; Neoplasm Grading ; Passive Cutaneous Anaphylaxis ; Pathology ; Prostate* ; Prostatic Neoplasms* ; Radiotherapy

OBJECTIVETo investigate the substance basis and the mechanism of pseudoanaphylactoid reactions (PR) induced by Shuanghuanglian injection (SHLI).

METHOD(1)The study of PR and the substance basis of PR of SHLI: ICR mice were divided into different test groups, the mice were intravenously injected with solutions of different concentration of SHLI, baicalin, forsythin, caffeotannic acid, positive control Compound 48/80 and normal sodium. All test substances were mixed with 0.4% Evans blue. The reaction and vascular permeability of the ears were observed and measured 30 min after SHLI injection. (2) The study of mechanisms: Mice were pretreated with an oral administration of Astemizol, intraperitoneal injection of cyclophosphamide 75 mg x kg(-1) or Compound 48/80 4 mg x kg(-1), then mice were intravenously injected with SHLI. At last, vascular permeability of the ears in pretreated groups was compared with SHLI treatment alone group.

RESULTSHLI of 300 mg x kg(-1) and 600 mg x kg(-1) caused obvious vascular hyperpermeability, but baicalin, forsythin and caffeotannic didn't cause vascular hyperpermeability in the ears. The Astemizol can decrease the degree of SHLI-induced vascular hyperpermeability of the ears in the mice. After intraperitoneal injected with cyclophosphamide, there was a slight decrease in the degree of SHLI-induced vascular hyperpermeability, but there was no marked changes in the degree of the SHLI-induced vascular hyperpermeability after the mice were pretreated with Compound 48/80.

CONCLUSIONSHLI in clinic equivalent dose can cause vascular hyperpermeability. Baicalin, forsythin and caffeotannic may not result in the PR of SHLI. The mechanism of the PR maybe relate to that SHLI stimulates histamine release, the activation of leucocyte maybe take part in the SHLI-induced PR, too. Antihistamine drug can prevent the genesis of PR which induced by SHLI.

Anaphylaxis ; chemically induced ; pathology ; physiopathology ; Animals ; Chemistry, Pharmaceutical ; Drugs, Chinese Herbal ; administration & dosage ; adverse effects ; chemistry ; Injections ; Mice

Postmortem chemistry is becoming more and more essential in routine forensic pathology and has made considerable progress over the past years. Biochemical analyses of vitreous humor, blood, urine and cerebrospinal fluid may provide important information in determining the cause of death or in elucidating forensic issues. Postmortem chemistry may be essential for the determination of cause of death when morphological methods (diabetes mellitus, alcoholic ketoacidosis and electrolytic disorders) cannot detect the pathophysiological changes involved in the death process. It can also provide many information in other forensic situations, including myocardial ischemia, sepsis, inflammation, infection, anaphylaxis and hormonal disturbances. The most recent relevant research advances on glucose metabolism, liver function, cardiac function, renal function, sepsis, inflammation, infection, anaphylaxis and hormonal aspect are hereby reviewed.
Anaphylaxis ; Autopsy/trends* ; Biomarkers/analysis* ; Body Fluids/chemistry* ; Death ; Diabetes Mellitus ; Forensic Pathology/methods* ; Humans ; Postmortem Changes ; Sepsis ; Vitreous Body

OBJECTIVE: To explore the expression of tryptase and chymase in human lung tissue of anaphylactic shock and its value for forensic medicine. METHODS: With ten carbon monoxide poisoning cases as control group, the levels of tryptase and chymase were observed by immunofluorescence and analyzed using the Image Analyze and the Image-pro plus 5.0.2. The positive mast cells were counted and the levels of the tryptase and chymase were calculated respectively. RESULTS: There was a statistically significant difference (P < 0.05) for the tryptase and chymase concentrations in the lung tissue between the anaphylactic shock group and the control group. CONCLUSION The levels of the tryptase and the chymase expression are greatly increased in human lung tissue of anaphylactic shock, which may provide the morphological evidence and reference for the diagnosis of anaphylactic shock in forensic practice.
Adolescent ; Adult ; Anaphylaxis/pathology* ; Cadaver ; Carbon Monoxide Poisoning/pathology* ; Child ; Child, Preschool ; Chymases/metabolism* ; Female ; Fluoroimmunoassay/methods* ; Forensic Pathology ; Humans ; Infant ; Lung/pathology* ; Male ; Mast Cells/enzymology* ; Middle Aged ; Staining and Labeling ; Tryptases/metabolism* ; Young Adult

OBJECTIVE: To increase the death rate of fatal anaphylaxis in guinea pigs and the detectahie level of the tryptase of mast cell in hlood serum. METHODS: Seventy-four guinea pigs were randomly divided into five groups: original model group, original model control group, improved model group, improved model control group, improved model with non-anaphylaxis group. Using mixed human serum as the allergen, the way of injection, sensitization and induction were improved. ELISA was used to detect the serum mast cell tryptase and total IgE in guinea pigs of each group. RESULTS: The death rate of fatal anaphylaxis in original model group was 54.2% with the different degree of hemopericardium. The severe pericardial tamponade appeared in 9 guinea pigs in original model group and original model control group. The death rate of fatal anaphylaxis in improved model group was 75% without pericardial tamponade. The concentration of the serum total IgE showed no statistically difference hetween original model group and original model control group (P > 0.05), hut the serum mast cell tryptase level was higher in the original model group than that in the original model control group (P > 0.05). The concentration of the serum total IgE and the serum mast cell tryptase level were significantly higher in improved model group than that in the improved model control group (P < 0.05). CONCLUSION The death rate of the improved model significantly increases, which can provide effective animal model for the study of serum total IgE and mast cell tryptase.
Allergens/immunology* ; Anaphylaxis/pathology* ; Animals ; Cause of Death ; Disease Models, Animal ; Enzyme-Linked Immunosorbent Assay ; Forensic Pathology ; Guinea Pigs ; Humans ; Immunoglobulin E/blood* ; Larynx/pathology* ; Lung/pathology* ; Male ; Mast Cells/immunology* ; Serum/immunology* ; Tryptases/blood*

PURPOSE: The incidence of adenocarcinoma on a subsequent biopsy following a diagnosis of atypical small acinar proliferation (ASAP) ranges from 34% to 60%. We reexamined radical prostatectomy (RP) specimens of patients diagnosed as having synchronous ASAP with prostate cancer (PCa) to evaluate pathological entities and the clinical significance of ASAP. MATERIALS AND METHODS: From January 2007 to December 2008, a total of 118 patients who had been diagnosed with adenocarcinoma on prostate needle biopsy underwent RP. Forty-six of the 118 patients (39%) were diagnosed as having synchronous ASAP with PCa on the prostate needle biopsy. Using whole-mount sections and prostate mapping, we evaluated the RP specimens that were close sections to the ASAP on prostate needle biopsy. All tissues were examined by immunohistochemistry with high molecular weight cytokeratin (34betaE12), p63, and AMACR/P504S added to initial H&E stains by one pathologist. RESULTS: Thirty-six of the 46 patients (78%) were diagnosed as having adenocarcinoma at sites of ASAP on the initial prostate needle biopsies. The Gleason score was 5 to 6 in 22 patients (61%), 7 in 3 (8%), and unknown due to multifocal and microfocal lesions in 11 (31%). The tumor volume of 14 of the 36 patients (39%) was 0.5 cc or less and was unknown due to multifocal and microfocal lesions in 8 (22%). CONCLUSIONS: Most ASAP on initial prostate needle biopsy was a true pathological entity, in other words, prostatic adenocarcinoma. Aggressive approaches including more extended repeat biopsy with additional biopsy of the site of the ASAP are needed to diagnose PCa in patients with ASAP.
Adenocarcinoma ; Biopsy ; Biopsy, Needle ; Coloring Agents ; Humans ; Immunohistochemistry ; Incidence ; Keratins ; Molecular Weight ; Neoplasm Grading ; Passive Cutaneous Anaphylaxis ; Pathology, Surgical ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Tumor Burden

OBJECTIVE: To explore the characteristics of autopsy cases of anaphylactic shock induced by cephalosporins and provide the evidences in forensic medicine. METHODS: Twenty cases of anaphylactic shock induced by cephalosporins were collected from April 2005 to August 2009 in judicial expertise center of China Medical University, and the characteristics of the cases were analyzed retrospectively. RESULTS: The age of decedents ranged from 40 to 60 years. Ninety percent of cases were from local medical centers and private clinics. The symptoms of the shock appeared 30 s-150 min after the administration of the drug, and death occurred 10 min-210 min after the appearance of the shock symptoms. In all cases, various degrees of eosinophil infiltration were observed in trachea and the lungs. Serum IgE detected by ELISA method was normal value in 14 cases. CONCLUSION In fatal anaphylactic cases, little specific findings are detected during postmortem and microscope examination. For this reason, the determination of cause of death in these cases requires comprehensive analysis combined with clinic information and excludes other diseases leading to the sudden death.
Adolescent ; Adult ; Anaphylaxis/pathology* ; Anti-Bacterial Agents/adverse effects* ; Autopsy ; Cause of Death ; Cephalosporins/adverse effects* ; Child ; Child, Preschool ; Drug Hypersensitivity/pathology* ; Edema/pathology* ; Female ; Forensic Pathology ; Humans ; Immunoglobulin E/blood* ; Infant ; Infusions, Intravenous ; Larynx/pathology* ; Lung/pathology* ; Male ; Middle Aged ; Retrospective Studies ; Trachea/pathology* ; Young Adult

OBJECTIVE: To study the expression of substance P (SP) in human sudden erethistic death, and to seek objective morphological supports to diagnose sudden erethistic death for forensic medicine. METHODS: The expression of SP was detected with immunohistochemical technique on 15 human laryngopharynx and gastrointestine of sudden erethistic death, and 20 sudden death of heart attack as control. The images of SP were analyzed by image analyzer, and the positive indexes (PI) were calculated. RESULTS: SP expression in the experimental groups was significantly stronger than that in the control one (P < 0.001). CONCLUSION SP expression can offer an objective morphological reference support for forensic diagnosing sudden erethistic death.
Adolescent ; Adult ; Anaphylaxis/pathology* ; Autopsy ; Child ; Death, Sudden ; Death, Sudden, Cardiac/pathology* ; Female ; Gastric Mucosa/metabolism* ; Humans ; Immunohistochemistry ; Intestinal Mucosa/metabolism* ; Male ; Middle Aged ; Mucous Membrane/metabolism* ; Pharynx/metabolism* ; Substance P/metabolism* ; Young Adult

27 autopsy cases died of anaphylactic shock induced by mainline during 1996-2005 were selected and analyzed. The results showed that most anaphylactic shock induced by mainline were rapid type and more easily happened in individual clinique and lawless clinique, and it could be arisen by either antibiotics or non-antibiotics. In some cases, there may be no pathologic findings by autopsy. So, all the materials must be taken into account for determination the anaphylactic shock, such as drugs, clinic symptom, autopsy findings, and so on.
Adolescent ; Adult ; Aged ; Anaphylaxis/pathology* ; Anti-Bacterial Agents/adverse effects* ; Autopsy ; Cause of Death ; Female ; Forensic Pathology ; Humans ; Infusions, Intravenous ; Male ; Middle Aged ; Penicillins/adverse effects* ; Procaine/adverse effects* ; Young Adult